2026-05-06 Abington Heights School District Board Meeting

001You are good. >> All right. >> Okay. Good evening everyone. I'd welcome you to the Wednesday, May 6, 2026 meeting of the Abby Tonight School Board. Please ask everyone to rise for the pledge. United States of America and to the republic for it stands one nation under God indivisibley and justice for all. >> We have a roll call. >> Certainly. Mr. Abdullah >> here. >> Mr. Azar >> here. >> Mrs. Henderson Mrs. Hillbrand, >> Mrs. Kum here, Mrs. Kho >> here, >> Mr. Moran >> here, >> Mr. Robson >> here, >> Mr. Aker, seven present. >> Thank you. Have a motion to approve tonight's agenda. >> Second. >> Roll call. >> Mr. Abdullah? >> Yes. >> Mrs. Henderson? Yes. Mrs. Karum? Yes. Mrs. Kho. >> Yes. >> Mr. Moran, >> yes. >> Mr. Robson, >>

002yes. >> And Mr. Azar, >> yes. >> 7 nothing. >> Thank you. Okay. Second item on the agenda is public comment. If anybody wants to address the board, uh, please step up to the microphone and state your name and where you're from in the district. And you'll have about three minutes to give comment. >> Good evening. Um, board members, superintendent, administration. Uh, my name is Carrie O'Reilly. I'm one of the co-presidents of the marching band boosters. Uh you've seen us here. Uh my colleague cannot make it. Uh we're here tonight. Uh you may not be aware or you may be aware our high school. To make this possible, we are respectfully requesting the use of two district facilities during the band camp period, the pit football field and a room in this building uh that

003can be locked for our band equipment. Uh due to football practices at the high school, an appropriate field is not always available to marching band. The pit is an ideal venue for marching band rehearsals. It provides the precise space students need to learn the formations, practice drills, and prepare for competition and performance. We understand the field has not been in regular use, and we are fully prepared to work with the district on the details of its preparation. We acknowledge that readying the field may require mowing and lining costs that fall outside our normal booster budget. We're asking the board to consider covering or sharing these expenses and we are also happy to explore whether booster funds or community partnerships could contribute. Whatever the arrangement, we want to be transparent and collaborative in this effort. We

004are also requesting an access uh to restrooms and a room in this administration building that can be cons uh secured with a lock. Marching band requires a substantial amount of equipment, including large instruments, music stands, electronics, and other materials that cannot reasonably be transported to and from the site each day. Uh, a lockable room would allow us to store the equipment safely and responsibly throughout the camp period. We recognize there may be a cost associated with keeping that uh area of the building accessible and secured. We want the board to know we take that responsibility seriously and we are open to whatever access protocols or supervision the district requires. The bambooers are not here to replace district leadership. We are here to bridge a gap so that our students do not lose an entire season

005of growth and opportunity. We have already begun coordinating with Dr. Tion and we have parents ready to volunteer throughout the camp. We will adhere to all district policies, keep records of the facility use, and leave every space in the same or better condition that we found it. We respectfully ask the board to approve the use of the pit and access to the administration building for the duration of band camp this summer. We're happy to submit a formal facility use request, provide a camp schedule, and answer any questions you may have. These students have worked really hard. They deserve to march this season, and with your support, they will. Thank you for your time and for everything this board has done for our budget. >> Thank you very much. >> Just ask where where was this

006held previously? >> I'm sorry. >> Where was it held previously? >> You just asked where the last year where did it prepare? >> Well, we sometimes get we'll get adjacent fields that aren't lined and for our students to know where they need to be placed uh it's it's terribly challenging for them. So a lined field which usually is not available especially when football is doing u double practices we get bounced around to >> various fields >> right >> that's that's no problem uh as you said uh once you uh submit in the the master library um I I don't foresee anything uh at the pit uh so we can go ahead and approve that and then the the lines are no problem. I would just ask that you think about how you want the line

007set up. If you want it set up like a normal football field, that's fine. We can do that. But we can also uh customize that uh if you want. And then we'll have this this um this building will be open so you have access to the bathrooms in those those areas. >> Wonderful. Thank you so much. Doug Palman, Newton Township. Excuse me. Better turn that off. Good evening, Vice President Azar, members of the school board, Dr. Schaefer, and administration. My name is Doug Palman. I'm here tonight as a parent of a student athlete in AMT tonight's swimming program. First, I want to say that I appreciate the time and effort that our coaches, athletic department, and board members put into supporting student athletes. And I know these positions require countless hours and often difficult decisions.

008At the center of every decision involving athletics, the best interest of the student athlete should always be the first priority. Unfortunately, in the opinion of many swimmers and parents, there have been times where that has not always felt like the case within the leadership surrounding this program. It has come to my attention through multiple credible sources that the current head swim coach has stepped down from the position. As of tonight, however, there has been no communication sent to swimmers or families confirming this information. if the position is in fact vacant. I believe the student athletes and parents deserve timely and professional communication from the district. In addition, I've also been told that members associated with the swimming and diving booster club may already be reaching out to individuals gauging their interest in the head coaching

009position. I would respectfully ask the board, is that appropriate? In my opinion, the process of identifying, recruiting, and hiring a coach should be handled solely through the administration, athletic director, and official district procedures, not through booster club involvement or informal conversations occurring behind the scenes. I would also respectfully ask the district to ensure that any hiring process remains free from even the appearance of conflict of interest or undue influence, whether from booster organizations, parents, or individuals connected to district leadership. Transparency and professionalism are important to maintaining public trust in the process. I also want to raise concerns regarding how coaching positions are posted and communicated to the public. When reviewing the district employment opportunities page, there is currently no posting listed for a head coach, head swim coach, or diving coach. In fact, this past

010season, the diving coach position was reportedly posted only about a week before triyouts began. Was never filled and still does not appear actively listed. I've got immense respect for all the divers who competed this season without a coach and had incredible success. Junior Ryan Horitz took second in district and freshman Reese Azar took fifth and I don't believe she dived before her freshman her freshman season. The boys team won mult won the league championship, the classic gold relays title, and the district 2 championships. Multiple school records were broken, including two individual records and three relay records. District records and invitational meet records were also broken. Student athletes such as Jason Casper, Derek Williams, Jeff Stanton, Charlie Voytech now have their names on the record board, which is an incredible accomplishment for both them and the

011district. On the girls side, the team fell just six points short of a league championship, a margin as small as a single event adjustment. The girls team won the classic gold relays, finished the season as district 2 champions. Along the way, two school records were broken by Hadley Palman. This program is filled with talented, dedicated athletes and have a very bright future, including strong incoming freshman class. However, some incoming swimmers and families are now hesitant about joining the program because of the uncertainty and lack of communication surrounding its direction. Some people may not realize that the high school swimming is unique compared to many other sports because high school season overlaps directly with USA club season. Many of these athletes compete in both simultaneously. They spend countless hours week every week training and competing. These

012athletes are deeply committed to the sport and deserve leadership that listens to them and communicates openly. Unfortunately, there's been an instance in the past where student athletes attempted to raise concerns or have conversations with coaching staff, athletic director, and administration, but many of the athletes and parents felt their concerns were not being heard adequately addressed. From their perspective, communication barriers were created instead of meaningful dialogue taking place. So, my questions tonight are straightforward. How are coaching vacancies communicated and advertised by the district? Are the positions only posted on the district website? Are outside publications, professional networks, or other methods used to attract qualified candidates? And what steps are being taken to ensure there is a fair, transparent, and professional hiring process moving forward. At the end of the day, this is bigger than one coach

013or one candidate. This is about maintaining the trust with the student athlete and families, protecting the integrity of hiring process and ensuring the success and stability of the Abington Heights swimming and diving program. I want to thank you for your time. I appreciate everything you guys do. I'm not used to standing on this side of the of the uh podium. I'm usually sitting on that side as a elected official of Newton Township. So again, appreciate everything you guys do for the community. Thank you. >> Thank you, Mr. Palmer. want to make comments on that, >> Doug? I'll I'll reach out to you because uh I I'm I'm unaware of of that vacancy. And that's not to say that um I would I would know. Um but I I I am I am unaware of that.

014And we are required to to make posts. I'll get you that information. But certainly we send out emails. We did a the uh uh the website. We also use uh a variety of uh uh per professional or like niche um uh websites. So, you know, we may be indeed for some uh we may go up uh uh onto LinkedIn and and and things like that to get those, but I'll I'll find out for sure. >> And I think the biggest concern is what happened with We don't want to wait till next October and then say we need a swimach. We know that it's going to happen or the person going to step down. >> I think with the talent that you have in the swim program, I think and the fact that we're one of

015very few school districts in district that actually has autiliz. >> Okay. Thanks. And I and I am being told that there's there's no resignation letter. So, >> okay. Is there anybody else to address the board? Doesn't look like it. All right. Great. Going to move on to the third agenda item, which is the superintendent report, Dr. Schaefer. >> Sure. At this time, I would uh like to bring up for a a healthc care presentation our uh healthcare consultants, Michael and Chris, to be here talking with you a little bit about this. I've talked about um our health care frequently. We we are um uh self-funded and we are not alone as an organization uh facing the challenges of increasing health care costs. We have been very uh proactive in identifying strategies that we can use

016uh with our consultants to mitigate some of these increases. However, uh the plan keeps uh rising at a at a clip that is you know untenable. Uh so we want to again uh talk publicly uh about uh health care and the and the things uh that we are doing. I have asked uh Michael Cummings and he has um taken a look at consortium pricing and and you know at at this point it doesn't uh appear as if there's any uh financial uh advantage to that. So we are uh continuing to look at our program uh which is uh collectively bargained with our um union colleagues to try to figure out a way that we can uh contain some of these costs. So thank you. Uh so good evening everybody. My name is Michael Cummings and

017uh my partner here is Chris Collins and uh we've been fortunate enough to work with you the district for a number of years. Um, we do work with other, it's kind of carved out a niche in that we work with eight other school districts in northeastern Pennsylvania as their consultant for your health and and welfare benefits. Um, we're pleased to do so and uh we've been working, you know, closely with your superintendent and business manager over the past few weeks and months um as we anticipate the upcoming uh plan year. Um, and so they asked us to come and give a report to you and so we're here to do that. Uh, there's a lot of information here. We're happy to have a robust discussion. Um, but I think we want to bring visibility to

018what your plan looks like and we've done that the past several years. You know, more about the data, deeper into the data, where how your plan has performed and uh some steps that have been taken collectively. you know, through us and our guidance, but also in concert with your administration and your your stakeholders in your, you know, your employees, your unions who who it's a collectively bargained benefit, as you know, and so have sat at the table to to craft the best plan that they can that you guys can afford. But, um, it's something that requires ongoing vigilance and examination to make sure that we're continuing to control that cost. So tonight you have a binder in front of you. Um and we'll use it for our discussion. There are four tabs as you uh

019may see and I know many of you are already sort of leafing through but I start off uh usually try every year with the first tab being outline of coverage. And so I think um it's it's good to use as a reference the benefit design that you have in place here for the majority of your employees. You know, in April, I think you had about 302 enrolled employees on a plan and essentially everybody, both teachers and administrators and other employees are on this Highark Blueare PO, $250,500 deductible plan, 2040 office co-pays. We use Highark as our administrator for medical. And as of January 1st of 2026, as you may know, the district um has its pharmacy carved away. So it's not an integrated solution. Um your employees use two different cards or two different vendors.

020One for Medical Highark. The other as of January 1st, 2026 is Save RX. They are a PBM, a pharmacy benefit manager who now administers your pharmacy program. And so the outline of coverage for the pharmacy benefit through Save RX is included in the PowerPoint. And you can see the formulary co-pay tier structure for medications um as part of the plan there. Um the next tab is the claim dashboard. So we're going back and we're examining all the way back to plan year 2021 2022 through current through March 31st. That is the most current data that we have. And so what you have is what we call claim dashboards, monthby-month claim payments, medical, RX, uh fixed costs, which are stop-loss, your self-funded to protect you against catastrophic claims, as well as, you know, costs that you

021would pay to high mark or your PBM to manage the plan. And uh and this these dashboards are meant to illustrate to you how the plan is performing in relation to your aggregate stop-loss insurance. And so that is some pretty nuanced information. And so what I did and what Chris and I did is we created a third tab which is kind of highle summary summarizing all of this data so we can talk about it from a high level. So the second tab is really you know tonight if you get home and you're ready to fall asleep and you look at this for about five minutes and you'll be out uh looking at these claim dashboards. I have no doubt but it's here for you. You can you can see all of the data. Okay. So,

022the third tab, and if you'll indulge me, um, and I apologize, um, we're going to go, if we're opening up the high-cost claim data tab, there's two sort of summaries of the data. One is more focused on pharmacy while the other is more general medical and pharmacy combined. That's actually second, and the pharmacy pieces first. I apologize. So, if if you wouldn't mind or if you're following along, you would flip to the uh portion that says Aington Height School District year-over-year plan cost trend analysis. Okay. >> So, um the data that we used again using July 1st, 2021, that's you know, your plan runs on a July 1 uh plan year. >> One second, Michael. If if you're trying to figure out where we were, find the little blue divider and the red next one.

023>> Halfway through the red section. >> There we go. Sorry about that. >> No worries. >> No problem. >> So again, we're using four full plan years and then now the current plan year through nine months. So over that time period, um we've had a net plan cost change. And when we say net plan cost change, we mean what was the paid claims for medical, paid claims for pharmacy. We include our fixed cost. what we pay to a stop-loss carrier, what we pay to our vendors, High Market, the PBM, etc. And then when there's there are instances where a claim or claims for an individual on the plan exceeds a certain threshold, in your case, $185,000, once that happens, there is a reimbursement from the stop-loss carrier because they're protect you against catastrophic risk. The

024net plan cost is what is the net plan cost of the plan when you factor in all those items. So over a four-year period annualized it's c gone up 30%. So about seven and a half% a year and you went from spending about 5.5 million net to in the most recent plan year $7.15 million. Okay. In particular your pharmacy has gone up 88% over a four-year period. And this is something that should sound frankly somewhat familiar to you because we spent the past really two years really honing in on this cost and it is the genesis for which we sat down with your administration with your union stakeholders and said you know we've had we've tried this with ESI we've take done an RFP we've looked at other vendors and we think that we can

025maintain the integrity of your benefit but do so with a different vendor and hopefully control cost and save money for the district, which is what we're trying to do. And this bigger increase on pharmacy was the genesis for that RFP that we ran. And as you know, it has been implemented as of January 1st, 2026. Um, from an aggregate loss ratio perspective, that is what the stop-loss thinks your maximum claim cost is and how it due to your net plan cost performance against that. In the most recent period, we're at 82%. Notably this year through nine months we're at 72%. Um so overall an executive summary plan costs have increased about 30% from 5.5 million to 7.15 million annualized. Uh it's driven this increase primarily by pharmacy acceleration as well as a sharp escalation particularly

026in the past two or three plan years by more high-cost claimments um and the severity of them than in previous plan years. um fixed costs have risen modestly. Um we've done a very good job from a stop-loss perspective every single year running an RFP looking at uh various stop-loss vendors to make sure that uh the district is paying the most prudent cost. Um and that has risen modestly. Um overall in particular in the past few years the plan has been offset by stop-loss reimbursements. Um so it's functioning as it should. Um but key insight here again pharmacy trend has definitely uh escalated higher than than the medical and uh for that reason it's why we took action within the past you know 18 months 12 months to to use a different vendor. Any questions? >>

027So the next few pages are showing you >> I got sorry I thought my mic wasn't on. Um how does that compare to other school districts? I would say to you that >> 30% in three years. >> Um I don't say you're not unlike others. You're not unlike others in four years. >> Yeah. >> You know, average 7 and a half% and I would say that in some instances you're probably beating the street for some of them. Um but what I what I am seeing and this is what a lot of our districts and we're advising to do the same things that you you've done is that the pharmacy due through due to specialty medications more and more coming on every single day and costing so much um GLP1s uh huge escalation you're like the

028others as well I would say >> okay thank you >> um medical and pharmacy trends trend here. You you can see the trend over the past several years. This is meant to show you what's our average number of enrolled lives. You've been pretty stable. You were a little bit larger four and a half years ago, 316 enrolled contracts. This year we're about an average about 302 303. Um but you've been pretty stable. Um you'll see medical reasonable increase over the past couple years with this year being an explosion. Um you know the gross cost is up 37%. Um much of that has to do with a few high cost claimments. Um for which we have received a very substantial stop-loss reimbursement um on um but the pharmacy you could see is pretty consistent. You know

029plus 13 plus 35 plus 23 in the most recent plan year 10 negative 10%. So, I'll attribute that a little bit to I'll say frankly maybe just a little bit of luck in the first six months because if you'll remember your plan runs on a July 1 to June 30. We did use the prior vendor Express Scripts July 1 through 1231. We didn't make the change to save RX until January 1st. But we'll get into that a little bit further and talk about just in the past three months the trend we're seeing that's continuing to to go downward and uh the steps that are being taken and some of the other items to continue to push that trajectory downward. So pharmacy is something that you know we see as a definitely an improvement and uh

030we're hoping that it'll continue as was predicted through our RFP and analysis. And Michael, if I just interject for a quick second, just a point of clarification for anybody that's listening out there, anybody in the audience, and even for our board members, but uh Michael's talked about the the the members that we have, which is it's been pretty stable in that anywhere from like 290 to 300 and that's just not that's not a number I don't use. I mean, pardon me, that's not a number I use. Um, you know, if I if I talk to uh Michael Holton, Chris, they'll we'll talk about belly buttons. And that's that's the important part here. While we have about 300 members, we're covering a thousand lives. So roughly 60% of uh the the folks that we ensure uh

031do not work for us and those are dependent. Is that accurate? >> Good. And that is good. Here it is. Uh, I I thought you might make that point and so I broke this down even further. So of the let's call it 300 employees that you cover on this plan um we'll say 50 50 we'll call 65 of them are covered as just themselves. They're just covering themselves, but the rest, you know, 235 are covering someone other than themselves, a spouse, one child, children, a family. And also of note, you have 190 spouses on your plan. So yes, that's how you get to a number that is 300 employees, but 950 members belly buttons. Okay. Um the next few pages kind of drill down even deeper showing you cost trend and you can see the

032net plan cost again reiterated from 2021 2022 up to current you know 5.5 6.3 7.1 7.1 through nine months we're at a net 5.8 eight and you can see the trend below in number in and bullet point number three our fixed cost you can see fixed cost again we're incorporating our stop-loss premium as well as uh cost paid to high mark any PBM to run the plan which would have been ESI now save RX um and I would say that we've done a very good job um in light of the way the market looks with respect to fizz cost so there have been modest increases there the last bullet point just gives you a little snapshot on high-cost claimant severity. Really in the past few years, but in this year in particular, we have more

033high-cost claimants and this would be uh those who have 185,000 or more in claims. And you can see just that total paid 2.96 million for that group alone um through nine months with 1.5 almost reimbursed through ninemonth time period. So, uh, key takeaways, pharmacy is the primary cost driver. RX pepm rose from 440 in 2021 2022 to $828. So, again, when you it's not as easy for me to say, well, our pharmacy cost or any cost was $2 million one year and 1.9 million the year before. We need to break down that into a per employee per month or a per member per month metric because you're you're not the same static enrollment. You're going up, you're going down. And so we compare that and you can see from 440 to 828 over a fouryear

034period. Little bit of a light at the end of the tunnel though in the sense that as we know in the most recent time period um we are in the 700s and we're going down. So down 10%. Um high cost claimment severity has accelerated as we mentioned. Stop losses working but that's definitely putting some pressure um on the A exposure. fixed costs are rising albeit modestly but it's something that we need to you know keep uh ongoing vigilance and examination of um so that's a high level from a you know medical and and RX perspective any questions if you if you'll indulge me next and we'll go to the first part of this summary um I apologize that they're not in the right order but this summary is meant to drive deeper into pharmacy and

035so um I will just make a comment. So you Abington is our third district within the past year that change PBMs from something to Save RX and um we're about to have a fourth district effective July 1 do the same. Um and other private clients as well. Um we worked well with them. um you only have three months with them, but three of other districts, two of their districts have used them now for almost 10 months. We're seeing a reduction in PEPM 20% plus. So, we're trying to get there and I think the clinical management that they're doing um and some other programs are going to help us get there. So, we're on the right trajectory, but um I think the transition went well. Um nothing goes without a hiccup when you're making a change

036from something one you know vendor to another but we've addressed those concerns as they came along. Um but they provided us about five days ago with a quarterly report which again I will make the same comment as I did with respect to the dashboards. I put it in here. It's for you to examine. If you look in the RX tab, there is a report that says prescription services quarterly report. And there's lots of information and data in here. Um, you know, I bet you'll fall asleep in a few minutes if you start reading this data tonight. But what I attempted to do here in this summary is take that information coupled with a previous 12 months worth of data to kind of compare them and make some commentary about how you're performing, what the trajectory

037is in the most recent time period, how it compares to to 12 months ago, and just some, you know, overall uh highlight some programs that the PBM is uh implementing has implemented. and is running that are making an impact on your plan. So an executive summary is that um our monthly average for RX fell 15 and a.5% from an average of 223 223,000 to 188,000 in the first three months. Um annualized if we're taking Q1 2026 spend annualizing that we should be somewhere four $500,000 plan spend less than we were in the previous 12 months. Um, your gross PEPM as I mentioned went from 8.28 to 738, $828 PEPM to $738 pm, which is a 10.8% reduction. And then of note, so they have this program called high impact advocacy and then a fraud, waste,

038and abuse program. They are making measurable gains and savings. Um, executive summary, key risks. One thing that we've noticed over the past several years, and this would be not unlike many employers that we do consulting work for, GLP1 anti-obesity um spend is your number one therapeutic class. 28% of your overall spend is on GLP1 for anti-obesity. Um specialty remains 72% of your overall cost. Any questions? uh is there generally seasonality seen in the um the cost of prescriptions year-over-year? So, I know healthcare as a whole, we see seasonality as you know, flu season comes to be and all those things. We usually see the same seasonality. >> I would say not >> because if we look at just Q1 of last year versus Q1 of this year, the improvements, it's still there, but it's slightly

039less if last year at 199 if we just look at Q1 versus Q1. So that's good. >> I know like in I work in hospitals and there's definitely >> seasonality hospitals. >> Um the next few pages um I'll try to highlight some items but a lot of it is summed up in the executive summary but I will say to you that um some things to take away um I think it would be important for you guys to know like historically we used to work with big express scripts optimum CBS and although they do fairly good job they don't do a great job right it's in the news you hear about it transparency things like that so Michael we spent the last 10 plus years vetting pharmacy PBM we've used a bunch of them we had

040one in here RX benefits was here a number of years ago that was smaller. You know, we kind of looked at them and let them run their course for three years, but we took it out to market and we uh landed on this company, Save RX. We have multiple clients with them, public as well as private. And to Michael's point, it's more boutique, more hands-on. I can tell you that from a service perspective, they do a much better job for the members. You know, We're hearing that and we have we have details that they're providing in terms of the number of calls they receive the number of calls that they don't have to call back on the first call. So just to put it in perspective, we're using a more streamlined kind of boutique pharmacy

041vendor. >> High touch, >> very high touch. You know, only three months in. I I got off the call today with the local bank. They've had them since October. And their was how refreshing it was to go from high mark which had this pharmacy embedded in the medical to this save RX how refreshing it was regarding transparency and service right and you know we are they are doing a good job we're in three months but we have a track record with them so hopefully they'll do the So just to give you something >> I know there there's a there's going to be a lot of information for the board to synthesize here but if you like just asked me in the street to tell you a little bit about healthcare and I'm not a health

042care expert but you wanted me to give you kind of like a a highle overview I I would say that uh the the following um and I'd start this way. I don't believe in luck. I believe in in math. Uh, and I learned that early on. For example, when I was in Philly, there's a lot of really good restaurants and I went to that Open Table app and I'm like, I couldn't get into like this restaurant or I got something was like six, seven months out. And I stood there for a second and then I had a hundred people in my office. I'm like, wait a minute. There's this there's a design to this. So what we'd all do is we'd all go on to open table and we'd all go and get reservations at

043different times. So at any point if any of the hundred people that worked in the office wanted to go to a restaurant, take your wife out anniversary, we could get into any place. That's just lucky uh by the design. So when we talk with our insurers here, what we're looking for is strategies to improve our outcomes. And uh right now when you're looking at these numbers like when I you know when we met I I did open up a window thought about jumping out uh and then I remembered that uh again what I learned in math is that outliers are volatile and sometimes the average doesn't tell you what's really happening. And what we are seeing is that there are strategies in place. So when we s decided to go with the new collective bargaining

044agreement to save our ex is that we are trending down. We know that we need some more months to call that a pattern but certainly we are trending down in that area. GL P1 that's a great example there. There's uh represent 2% of our claimants. those thousand but make up 28% of our spend. But we're going to talk a little bit about a strategy to kind of mitigate that. What is not in our locus of control are uh high cost claimments and that's just uh something that we don't control. Sometimes uh folks get really sick and they have to spend uh unfortunately time in the hospital and uh ongoing treatments um which are which are expensive. But just so you know, we have strategies there that we don't talk about much, but it's good for

045the board to know. So, for example, and I'm telling you this because I did not know about this until I I talked to Michael and Chris maybe like a a month ago, but we were talking specifically um about cancer and high costs and just a a general conversation about that. We have a a vendor that our consultants reach out to where they will discuss confidentially and privately. This is why all this information is anonymous about ways that we may be able to uh maintain the integrity of the treatment but do it in a way that's a little cheaper. So for example, if somebody uh has a diagnosis and they're being treated in a hospital, but there can be treatment at home through a traveling nurse or otherwise. oftentimes we could capture some savings and we

046haven't changed anything and then in sometimes they may come back to us and say no this has to be done in the hospital. So, I wanted to make sure that I I I brought that out because when you start to look at the per employee per month, that that that can look um a little a little scary. But baked into that with health care is sometimes there are these super high cost claims that just drive that average out of the park. That's not unique to every public or private high claims have increased to new tech new techniques new medicines stem cell transplants J codes I mean so it's across the board that we have and try to every day what we do for sure. >> Um, if I can I'm going to try to kind

047of bring it home a little bit. I'm sure you guys have other things to talk about, but um, within this particularly pharmacy uh, analysis, I'll call your attention to the two programs that frankly I I feel like are new to us with Save RX that we didn't have with VSI. this high impact advocacy program, manufacturer fraud and abuse prevention. The first being there were 90 claims um where they were able to garner manufacturer discount which resulted in savings of $83,000 to the plan. That was just in the first three months. Um in the RFP that we ran where we had them look at a 12-month snapshot of all claims, their number, they're actually hitting that number. I looked at it today. it was like 340,000 that they thought this is what we can garner. So

048through three months we're on track to hit that number or they are the manufacturer fraud and abuse could be a medication that was high cost low value. Um there were 17 medications for 14 users that you know they were redirect directed to something else that garnered $89,000 worth of savings for the plant. So those are the types of programs that we knew we would get with Save Our X and was part of the reason which drove the decision to to change vendor and I'm pleased to report that it's happening. It's working. It's working for the plan. Okay. Um I I'll then make two points and and talk about like further work that we're doing. So and that Save RX is doing in the tab that says RXGLP1Rvive. There's a slide in there that talks about

049Save RX's impact program. So, it's a program that they have where they utilize a separate vendor who is able to garner 340B pricing for certain high-cost specialty medications. And as we work towards our annual renewal and uh new plan anniversary, I had them key in during the transition. What was paramount and hallmark was we want the least amount of noise and disruption as possible. And we made that commitment to your union that we're going to grandfather members where there may be a formulary disruption, but we're going to try as much as we can. Although we don't perceive much disruption, we want to make sure that you're maintain the integrity or benefit getting the medicines that you have. It's just using a different card and a different vendor. And I feel like we did that. But

050now the transition is over and my task to save our ex for you. But what it has been for our other clients who are now 9 10 months into this thing is okay mine the data. Are there programs whether it's a patient assistance program a manufacturer's program or this 340B pricing program where there a medication that's being utilized by a member of this plan can be sourced a different way which will save money for the member. So albeit the members have low cost share, maybe it's a $15 co-pay, any of these instances, these programs, the member gets a $0 co-pay. So they're saving something. Is it a lot? No. But it's something. But it's a pretty significant reduction in cost to the district. So there were four medications, five members highlighted that have been taken

051in the past three months, 90 uh days, whereby the projected annual savings to the plan is $127,156. So that is in the works now. Like we're over the transition phase. They are engaged. They're going to be talking with members and these me these medications that they're taking, they're not walking into CVS to get them. It's a mail order pharmacy. It's being direct to their home and and so we we're going to make sure that that happens to control cost for the plan. The other program is is GLP1. So, um, about a month and a half ago, I was, uh, on LinkedIn and I saw a vendor that we utilize and do business with. They're called Revive Health, and they're a telealth company who does a number of items. And they posted something. The CEO said,

052"We were now selected as Eli Lilly's vendor to uh, distribute direct consumerdirect to employer pricing for GLP1s." And I saw the flyer and it was like, you know, Zep Bounder will go $395. And I was like, okay. Call them up immediately. Hey, you need to tell me about this program because I knew what the cost was like here. Okay. And so we're we're in negotiations with them or discussions with them about how the program would work, but I did do an actual analysis for you and it's in here. It's It doesn't look pretty because it's every single claim that was dispensed between January 1, 2026 through March 10th, 2026, but it's the last page in the entire booklet. It's really small, but basically what this says is during that time period, you paid ingredient costs

053for these medications of $115,554. members paid mostly a $15 co-pay, but $1,515. Yet, and this is why I was very thorough on this, this analysis took us a couple weeks to do because I wanted to get the proper information from Save RX. Every time someone takes a brandame medication, there's a rebate from the manufacturer that they negotiate that comes back to you 180 days at the end of the close of the quarter. So, it would be unfair to just say, look at this new direct to consumer or employer pricing. It's definitely less compared to what we have. But you need to factor in not only the ingredient cost and the member cost share, but you also must factor in the rebates because if we carve that away, we lose the rebate. Nonetheless, as you can

054see, the net cost during that time period, January 1, 2026 through March 310th, 2026, was 93,580.70. The cost for every single one of those medications, same med, same dosage, was $39,5001. And so you're on pace to spend about $650,000 just on GOP ones alone annualized. And we think projecting and extrapolating out that by maybe carving this out, this could yield somewhere between 200 to $250,000 worth of reduction in cost. So, we brought this to the attention of your administration and uh it's something that we're going to be having discussions with with your stakeholder, your union to talk about, you know, just the notion that this is what we found and uh just like we did, we brought them to the table to say, "We'd like to consider another vendor. We want to maintain the integrity

055of your benefit, but we think we have an opportunity to save a substantial amount of money. how can we work together to maybe implement this program? >> And I'll give you again Chris's summary of this. Um, this is the difference to me between like active and passive management. I'm pretty sure Rod's an active manager. >> Um, this far exceeds whack-a-mole. I call it the Tvago effect. If you've got, you know, if you had to go anywhere in the last whatever decade, whether it's a a family reunion, you go to see your kid at college, you know, back in the day, I could call a hotel, which is what I would do, say, "What's the best price?" And they would say, "Are you AAA?" That was like the only card I had. My grandma bought me

056a AAA membership when I graduated high school. So, I got $5 off, right? But now I know I can't call a hotel because I'm going to get an astronomical price. I called uh a hotel at at Penn State. I want to go out and visit some friends and I won't even tell you the number. I was like that's ridiculous. And I went on Tvago and they're like Booking.com, super.com. All these.coms I've never heard of, but they were all two $300 different. I'm like what? It took me a half an hour to find the best price. I had to be an active manager to do that. So, at the end of the day, I ended up saving myself about $300. But that's what I had to do. So, when Michael tells you that we have to

057be vigilant, I would say we have to be hypervigilant. So, let me be clear on this. When we talk about the GLP1s, we are paying on average anywhere from $1250 to $1,500 for every single injection, right? That's the price that's uh negotiated with the PBM. I don't I don't mean this. This is hyperbole right now. I don't care about the coupon. That's like every time I walk into a a furniture store, they're going to sell me the mattress for 50% off. Well, you know, you're not giving me 50% off. There's some margins in there, right? They're giving us a manufacturers's rebate and we're still doing well and still on schedule to save $300,000. And that's what we're talking about here. We have a collectively bargained agreement, right? So when we take a look at a

058GLP one, that's that's what we're paying. We we can't say, "Hey, we're not going to cover GLP1s." But there are plenty of organizations, perhaps some that you work with, that this got so expensive, so fast, like all the school districts and businesses are noticing, that they dropped them. So, Michael's friend here, what happens when you're Eli Lily or Novo Nordis and you see that you're losing 1250 in injection? you go direct to consumer. And so that's what I mean by whack-a-ole. We will always be actively managing this, looking for places where we can be creative to to purchase uh different types of drugs. So this revive program though kind of puts us in um a more proactive health management space uh because we are looking at offering our employees our staff a um basically a

059wellness program from what I am reading and correct me because you know just brief summary. >> So you read the PowerPoint. >> Yeah. >> Well this one. Yeah. >> Yeah. Yeah. Yeah. >> Yeah. No, I mean, but I read it while you were talking, so you know, >> I mean, like, Yep. It was there and I knew somebody would read it. >> Yeah. So, I'm just making sure I'm I'm I'm reading this correctly. Um, you wouldn't go to your GP to get your WGOi. You would go to and I was actually the wellness coordinator for UPUPIT because UPMC did the same thing, right? Like if we get people healthier, we spend less in healthcare costs, etc. So um so you would it the only concern I guess I have is that it puts us in

060a more active space in terms of that preventive medicine wellness management and I just and it's not even a concern but the questions I guess that I would raise >> that's my that's so my question to you I asked him no I think that's what >> here's my resp my response to this is this my first Um the way in which I got to this was it was there's cost right how can we this is an extremely fast-pacing escalating cost is there a better way to do this it looks like there is but then once it was like oh the numbers are clear but let's learn more about the program and um we've been active engaged with this company revive who we do other business with from a tellah health perspective but this is sort

061of a new you know program for them and learning about uh exactly how it would look when interface between the member and them and I think the numbers are clear and I think the notion of maintain the integrity of like I was getting this medication before am I going to get it now I believe that's clear as well but I think a little bit of a difference frankly is that they are a telealth company who has physicians on staff and this is going to be certainly a concern from from the union's perspective like hey now I have to engage with the provider And we were having some conversations with them today that they they were saying we were we're throwing at them somewhat curveballs like well what if you know we're still going to take

062the prescription from their general practitioner. Yes, but we really they're like well I think we could maybe bypass that. With that being said, we don't think the program would work to its fullest benefit if the member was not engaging with our physician because as part of the program, the program is not just about like dispensing a med. It's all about like working on outcomes like monthly engagement with the physician with a coach to make sure that like you're what are your goals? You know, are there also what other medications you're taking, co-orbidities? Um, and like are you meeting your goals? Are you actually working towards something? And there definitely is an active participation part of this. And so I don't know how that may be perceived on the other side of it is like I

063don't want to do this. >> I don't think it's the worst thing in the world. >> I'm not necess uh I'm not necessarily opposed. I mean we were talking about this recently like the fact that we are negotiating um prescription prices and um healthcare to this degree as a public school entity is is sort of wild in the first place, right? So, um, and offering this, it's a it's a benefit because one of the other things with these new weight loss drugs is that, um, we're finding that, uh, people who take them that aren't necessarily deficient, um, in the are who are taking them for obesity, not necessarily deficient in the u, what am I blanking on the word? It's not a hormone enzyme. What is it? >> Yes. Um, when you are on them

064for life. Um, and this program seems like it would be a way to structure that so that you know we aren't this isn't a lifetime medication. Um, and it would offer coaching and all the other things. I I don't necessarily I think it's a it's a benefit. It's a add-on. It's a it's a value ad. So, um, not necessarily oppose, but just the idea that it is new and it is entering or tiptoeing into a space that is >> this wouldn't be our first time doing business with this company, Revive. They do other things like primary or primary teleaalth, urgent care teleaalth, um mental health as well. But they have a weight loss program and now as they were selected as one of the vendors to distribute noonoris and eli direct to consumer pricing, now

065they're running with this thing, but they're not the only one. There's other vendors doing the same thing. And so we came to this as our job is to make sure that you guys are we're good stewards of your plan, making sure that you're paying the per cost. And when I saw it was just clear over the past several years, you went from, you know, 100,000 in spend to 250 to 400,000. Now we're on pace for 650,000. You know, how can we do better? And then when anybody watches TV and you say, "Oh, there's a direct to consumer. Why are we paying $1,200 ingredient cost? We get a rebate at $200." Okay, net cost of $1,000. Why are we paying a,000 when the cost can be 375 or 250? >> Right? And I just think from

066a like looking at the big picture, we're doing one thing here, which is um making sure we can balance our budget with rising health care costs, right? But from thinking about how we uh treat our staff and the culture we create as a um in the environment of the public school, this I think could be a value ad in the sense that we're trying to provide more access to care. Um and we've talked about that with mental health resources too for students. So, you know, just thinking about the ways that we use technology to um provide more opportunities for our staff to access this kind of care. Um I don't necessarily think it's a bad thing. I just wanted to kind of raise those questions. >> I'm mine are more boring. So I mean I

067I agree with you're saying there's access a positive access to care. I had a question on the numbers just so when we pick up provider >> um so in the red section under the high level RX cost summary that is that supposed to be pulled from the tables in the previous section. Um >> so like if we look at the the >> tell me the section. Um so in the highle >> data summary y >> page two >> right so that the total RX page >> should then match the the year present in the previous section >> right >> yes >> so >> right that's I I think because in the previous section the numbers I could just show you the numbers different I was just curious what made the difference unless I misreading it

068which could be possible too so in the if we look January 25 here this is saying 283,000 and on the the dashboard next section it says 196,000 >> I'm not sure why it would be different but I could certainly clarify >> yeah I just curious because if if the first section's right your number is amazing if so and then the other question I had was in the last table that's is that all of the um highc cost medications so we talking about like the weight loss drugs is that all of them for the year Nope. That's just specifically GLP1 on that last table >> because we look at I mean the savings is great. Every savings is good, but it's like 80,000 versus the 1.6 million. >> That's just that's just GLP1. And so what

069I would say is I would then point you to to take a look at the Save RX quarterly report for the first three months where it's not only listing, you know, GLP1, it's listing lots of other specialty meds of different therapeutic >> much higher like you're going to see some acute care. You'll you'll know. Yeah. >> I know we're not going to say $1.6 million, but like >> it just seems like a small. >> Yes, sir. What happens like if you get into the tea tellahalth med conversation, right? What if the your tella health and your real doctor disagree? Because I know that's >> we were having that conversation today. >> Yeah. >> Basically said, you know, there's 45 people taking GP1 >> GLP1's for anti-obesity >> for anti-obesity. You know, submitted it in getting

070the drug under this program the revive doctors you know don't approve it so that's going to be an issue potentially >> so a revive doctor has to approve the drug to get it >> I think it's um >> I know that we're having this we're going to have a meeting >> I specifically asked that question because I I did not want to take guard rails off. So this is like a value statement. Now in order to get on a particular drug, I think you should see your general practitioner or a health care professional who then will talk to you about your symptomology and test and do whatever. So when we're talking about a direct to consumer model that we all see now on TV, I wanted to make sure that whatever we did, we maintain

071the integrity of that. So you couldn't just wake up and say, "Hey, I'm going to get on GLP1." You would have to speak with a doctor. You would have to have some tests. We have to make sure that it's safe. It's appropriate. Um so that was really important. So that's >> I'm I I appreciate your question and that's something that we are anticipating. What and I think that's the question that's going to come from your stakeholder which is what if what if one of us right now has been taking this medication not only prior prior to January 1st with the other PBM and it was approved. Um I would frankly say that I think Saberox did more strict clinical oversight to make sure that they should be taking it and reviewing clinical notes. But what

072if the member ends up if this rule is rolled out July 1st 8191 and then all of a sudden two months down the road that this provider says I don't think you're meeting the criteria you're not adhering to the program that member I mean you're that member is going to say wait a minute why do we agree to do this program nothing would have changed for me >> if we just kept going the way the trajectory we were going why are we doing this >> but let's play devil's advocate too here what if you it looking at this um as like a marketing perspective. Revive seems like it would want to approve all the GLP ones. And what if it encourages more people to use GLP ones and our cost savings are no longer >>

073We talked about this. >> Okay. Because everyone's now taking them because they're getting immediately >> Yeah, that's definitely I would bet money on it. you're going to see but even if you go up in 50% in usage you're still going to have like 40% savings versus >> cost the way in which so just be clear because it's not in here or it is actually in like the last page of the PowerPoint it said so what they do is they charge a fee of eight I'm sorry $9 per employee per month so they're charging a fee to administer this program for every employee despite the notion that at this point we only have 45 users so $9 time 300 people times 12 that is their cost to manage the program. And uh that was certainly like

074in our first discussion about this Chris that was probably the second thing that he said which is like hey what if now we the cost is clearly 50 to 60% less but what if we have somewhat of like a run on the store and that was our ask of them which is how can you assure us that there will be a level of clinical oversight and management so that this isn't some like run on the store um that we didn't go we don't go from 45 users to 100 users. It's certainly a concern. I mean, it's in my opinion, it's worthy of the discussion we're having today because the cost is so great. With that being said, it's something that we certainly need to work through and parse out and uh you know, we'll certainly

075keep you guys a breast of what goes on and you know, even what the discussion yields when we have it tomorrow with your stakeholder and what they think of this program. >> They have no go. >> I'm sure they have a protocol >> to I frankly think you shouldn't take it. >> I think it's more of an outcome based program looking to get better outcome for people whereas >> they wouldn't be the main prescriber. >> No, no, no. I think it's geared towards like not to say uh Chris I think is trying to say is um >> so when somebody gets on the drug they want to have like interaction with that person that they're doing things to to get better to eventually get off >> the right so so like my firm one digital

076they I've talked to Michael about this so they have you know members under we're in all 50 states million people that one digital has in their database that they are looking at from an analytic standpoint and they've started to come and analyze GLP1 for weight loss and in various companies that have that allow GLP1 for weight loss. Okay, over a period of time those companies emergency room visits have spiked 10%. So there are we don't know what effects of GLP1, but they're starting to see that in the data people are getting have to go to the emergency room mainly for like gastrointestinal problems. So I think it's you know I don't have the answer to this about how to reduce GB1 for weight loss for folks that don't need it or that can solve their

077weight loss issues in a more in another way >> because also when early with the high gain weight. I mean, that's why >> it's not only used for weight loss anymore. >> So, well, we're just talking about >> weight loss weight loss. >> We separated. >> Looking at the data, there's if you look in your this report, the quarterly report, you'll see Mjaro and Ompic on here because someone is a diabetic. They're taking it. We're not talking about that. And I I think that if I went up to like 30,000 feet and said, you know, what problem are we trying to solve for? This is Chris's thought on it and you know, this is a cynical viewpoint, but I think the data would support me. The lover of change, at least in my thought growing

078up, was the doctor always knew. I went to the doctor. He prescribed something. I didn't know what that was. I took it. I got better for the most part. So why is it now that we turn on the TV? Wherever you go, you hear it because we're no longer that lever of change. And and and that is supported by the evidence of these specialty drugs, the proliferation of those and how those are are are getting uh prescribed to people. So you you see it, you go in to see your doctor and say, "Hey, I want to be on this one or I want to be on this one or I want to be on this one." And that's when we take a look at those special drug. What is it like a 70% increase? These

079are things that the consumer was just kind of un unaware of. >> I had a couple questions. This um this program with revive is it just for GOP ones or is it for all drugs? >> It is. Well, this program is just for GLP1s. They have other programs like uh again a mental health program, teleahalth meal. They have a primary care tellah health. They have an urgent care tellah health. >> Oh, no. I I meant like if they're going to go direct to consumer, is it just direct to consumer for GOP ones or is there an opportunity to go direct to consumer with other drugs? >> Just for >> just GOP ones. >> Just for the GOP. >> Yes. >> My second question is numbers. Uh you've talked about some cost savings it sounds like

080are already happening with Save RX, right? But a lot of those savings have not happened yet. They're like potential savings that we're hoping are going to continue and get better, right? Um and then these potential savings in the revive program, nothing yet, right? So that's fine. So that's I'm just trying to say how much potential, you know, opportunity we have to have a better healthcare outcome because it's been horrific on our budget. uh the projection here that's in here and I know you pull these numbers from other sources but the the net plan cost trend numbers that's our total the school district's total cost what we pay for you know self- insurance on claims self insurance on these drugs and then the stop-loss insurance and everything that we're putting out for for healthcare correct so

081the trend this year has a little bit of savings in it from Save RX X. >> Yes. >> Right. And even with that trend, we're by by my math, if it's linear and it's not seasonal. I don't remember what your answer was to his seasonal question, but >> not. Okay. So, if it's if it's just if you just annualize 5.82, we're trending at 7.8, right? 7.75. So, that's a 8% increase, correct? >> Right. So, that's bad. So, even with And you've had some savings with Save RX. And even with that, >> I'm just underscoring >> it does get worse. This is great, but >> I can I can give you a version that's worse. >> I I mean, we and I and I've told the board this before, but it's kind of like that. And

082please tell me if I'm summarizing this wrong because I'm like um I had said that we had another catastrophic year. And when we say catastrophic year, sometimes those are just a a couple high-cost claimments that come in which you which which is uncontrollable. But what happens is that when that does happen and there's no track record of it, then most likely stop-loss kicks in. So we'd get reimbursed through a stop-loss carrier. So we get money back. So in aggregate it may look like a break even year or close to it. The following year, you're going to get hit because we're going to go out the RFP for the stop-loss carrier and they're going to know what they paid on and they're going to raise those deductibles for those high cost claimments up. So, to give

083you an idea, Chris, I'm going to give that back of the book math that I did here. So, you know, correct me if I'm wrong. Um, so when you have high cost claimants, the deductible is higher, right? And then you have your stop-loss premium. And to be clear, we put out an RFP to 16 companies and I think 14 didn't even bid on it. >> 18 two two bids and the premium is going to go up. Last year was around 450. I expect it to be around 600. This year somewhere around that. And the deductible for high-cost claimants, you got to think about like, you know, you're going to pay that, right? like they may say, "Hey, Chris has is sick, so the district's responsible for the first $300,000." So, you know that we're going

084to pay 300. So, before the year even starts, we're 2.7 million in about right somewhere in that area. >> That's if every single person get their So, what he's describing is concept called lasering. So, you're standalone and self-funded. You have a specific and an aggregate attachment point. Right now the specific attachment point is 185,000. Okay. However, when you have a year what's happening today where we have more high cost claimments and that the underwriters at the stopwatch carrier say we perceive that what's happening today for which we've reimbured a significant amount may be ongoing and happen in the future. we are going to laser that particular person and have a different attachment point for them than everyone else does. And so the current carrier is saying, "We're un we're willing to accept you again in

085next year. Um we're going to increase your costs um about $180,000 to assume the liability. However, we're going to identify this particular person who's had significant claims to reimburse and we're going to change their attach to something else. And they've done that with one of your high cost claimments. And uh with that being said, for two or three of the others for which they are focusing on that as well, the numbers are significantly lower. However, and this is something that we continue to work on, some of the information that we supply to you in the back of the RX tab that says impact, some of them were because of pharmacy. Often lasers will come because it's a predictable cost that you know is going to happen. A member is going to continue to take this

086specialty med. It's going to cost X and they're basically saying we're not willing to take the risk up until that point and we'll just raise it up to here. So, let's say the medication cost $20,000 a month. We're going to laser this person to 250,000, which essentially is you paying all of that cost up to this point, which may be different than the $185,000 specific stop-loss deductible that everyone else is at. Through the information that we just got actually from the PBM uh last night where if the medications run through this impact program, they're significantly less. I think we're in a position to renegotiate with the stop-loss carrier on those carriers. But I will be transparent with you and say like your number one high-c cost claimment that's not going away in the sense that

087like they're not going to budge off that number of that laser which is 975,000. Um so it doesn't mean that you're going to pay that next year. It means that should that ongoing risk continue and it's similar to what it is this year which was through nine months 1.5 million 1.7 million in claims and they've paid about 1.4 reimbursed. They're saying you're going to assume the risk up to this point 975. If the person's condition improves, if they go off the plan, then you don't that's not your cost, right? Um but uh we are working on that but there and we're working on projections with respect to budget to to give you those numbers but you are not wrong in your number of looking at that and saying if we're at 5.8 what is our

088net cost over the next three months. >> So put this on the list of things that I didn't know when I joined the school board and the list is really long. Uh >> I did not know that stop-loss insurance providers lasered you. So, I thought when when I first learned about this insurance that we had that we're so I didn't even know we were self-insured before I joined the board, right? So, then when I learned that we had stop-loss insurance, I thought, "Oh, okay. We have stop-loss insurance, so we can only lose so much." But the reality is that if you have people that are getting serious care, you your stop-loss gets blown apart and your liability is still with you. you don't really, in my opinion, you don't really have, you know, uh, ultimate

089stop-loss insurance. So, my question for you is, is are there providers out there of stop-loss insurance that don't laser and just charge higher premiums where you can like >> So, but then that's that's a trade-off. It's like >> Well, I mean, >> so explain more about that, please. And and you can it could be a model where you're part of a group cooperative where one of the tenants or provisions of the stop-loss policy is like a no new laser provision and um I would say that >> so like we're paying I'm sorry to interrupt. I just I'll forget if I don't say it. We're we're paying like 450 last year that's what you said is going to go to like 600. So like what if we paid a million because like this variability is unbelievable.

090like you're talking about millions of dollars right now because we have seven claimants. Like what if that goes to 10 or 12 of like it could happen, right? And so like that risk when you're trying to put a budget together to me, >> no doubts. >> I think what you the tradeoff is you could look back and say over the past five years I paid double the fixed costs and every year I got a 15% increase on my stop-loss premium. Yes, it was like easier to budget my or you look back and say, well, over the past several years, like my fixed cost has increased an average of 6%. I've kept my fixed cost down, but it has been more volatile and variable. It's just >> not say a better way to do it. It's

091two different ways to do I think that you put it I I I asked a very the same question and I always say this tell me if I'm wrong when I summarize it because I did not close the learning loop with you today but you cleared it up really well today when I asked this question about the consortium because I too had that question and so when we went out to look at a consortium so like we are sharing the risk right we're going to go to a pool of people and Michael said Chris Well, I gave them the information, but again, this is like actuaries. They're going to they're not just going to say, "Yeah, come and join our club." They're going to look at our data. They are going to see the risk

092that we may see in the laser. They're going to add that up. They're going to put their margin on top of it and then that's the number. So, they'll say, "Okay, Abington Heights, you want to join this consortium?" All right. It's going to be a 23% increase this year and we could get a cash flow >> and you still got you still have that same risk. >> It's just it's diluted in a bigger pool to >> your to your point. >> But you have but is that the only option consortium only or is there just that's it? >> Yes. And I would say we're not done with our marketing results like we're still waiting for a proposal like definitively from a consortium of option that we do do business with to see if they would

093accept the risk and what it would be at. >> And I'll just give you an example. We have one cooperative that we have multiple smaller schools who are part of and um you know it's I think it served them well but it's also I think specific to the individual school and you know cash flow perspectives and kind of like who you are and what your size is too. I think you've been at a size 300 plus where you have had the ability to sort of stand on your own but there's no doubt it's become more it's become certainly volatile over the past few years. Um we're not done with our marketing results and uh it could be an option. Um and so more more to be seen and to deliver to you. Um but again

094you look at that from the perspective of I I know this for a fact because there is another cooperative called the NEIU consortium. They have a healthcare consortium and um one of their their schools called me about a month ago and said like I can you look at our plan. we can't do anything for this year, but like I want you to review us for a following year to see if should we stay in this thing or should we leave and um everyone got a 23% increase. So, every single one that's how that cooperative works. All for one, one for all. Not saying it's a good thing. I'm not saying a bad thing. That's how the philosophy of that cooperative. So, there's definitely districts within that cooperative who didn't deserve a 23% increase, yet they

095got one, >> but they're still getting lasered. They're just a bigger group, right? >> Don't know. I don't know specifically the tenants of that of that cooperative, but >> it's that dynamic that like I get the whole like, you know, economies of scale thing that could be beneficial or it could still be bad, but like it would be it would be great if there was I just that laser concept to me, I had no idea until you told me about it a few, you know, weeks ago, whenever it was. And I was like that to me is a risk that I had no idea we were exposed to. And it's really big. >> Sure is. No doubt about it. Yes. >> So, you said it's $9 a month per employee, correct? >> So, whether they

096use it or not. >> That's right. >> So, what about spouses? How did that how does that factor in? >> Um, they're considered as an employee like they're part of the family unit. >> So, we're not talking about 300 people. We're talking about upwards to a thousand. >> Nope. You're charged PF per employee. >> Employee. >> Okay. >> So, it's that 300 times the 9 times the 12, >> right? So, >> 32,000, right? 32 a year, but then so if an if a spouse wants to, it's not like an additional like add-on. It's just like a flat almost like a family family rate. Okay, >> but that's not included in when we look at the costs on the last page, the 39,5001 was just the cost of the medication. >> That's just a sheer repric.

097Here's the claims that were incurred and paid during this time period. >> This is what your ingredient cost was. Here's what the member cost share was for every single one. This is what the rebate was. Here's your net spend. And that was not factored into it. >> So to operationalize that is actually almost $72,000 versus the 93 we paid today. So still significant savings, but >> and it's but also you you're we're looking at we're talking about an annual cost of the program and that's three months and 10 days worth of data, right? >> Oh, that's four times that. >> This is only three months. >> It's four times that 100 days. Yes. >> So then what would the next steps be? Because we're talking about all this tonight trying to figure out, you know,

098what's the best way to go. So where do we go from here? >> So we have a collectively a bargained agreement. So we are really specific on this and within that agreement we put in to have a healthc care board so that we can be more nimble and make these changes when they come up so we don't have to wait four years, three years, five years, whatever it may be. So tomorrow morning we are all meeting with the union representatives to talk and present revive so that we can capture some savings and it it will be discussed just like it's discussed here. The first thing I say is you know we're looking to uh get some cost savings without diminishing in any way the integrity of the care. you're still going to get the same

099thing. And for the most part, if anybody knows anybody on specialy meds, those get mailed out anyway. So when you when we when we switch to a PBM, a lot of people didn't even know that you're just they're just getting it in they're getting it in the mail. Um so I am I'm hopeful, Miss Henderson. Uh because what we would we would like to do is you know discuss this with the union and would would love to get anou so that we could start this July 1 because this would be significant savings over the course of the year for us in a on a therapeutic class that is running away and quite frankly uh is just uh too much to spend. I told uh Michael and Chris and and and Jim this morning what I

100would uh uh tell you and certainly I don't make this decision. I I I make recommendations to you all but um at at some point it's a design issue and and not a budgetary issue. And what I mean by that is we cannot continue to just budget more and more and more and more into healthcare because it would it it's just it it eats away any type of headwind we get to do anything with our facilities with our adding teachers and programs and things like that. um we have to either what we're doing now, we work with our union to try to get um some changes or we we have to make uh cuts. >> Don't we have a do we have a um contract with Save RXO? Because you'd have to break that part

101off. >> So, good question. And um we brought this to them transparently. and just sort of said a month ago like, "Hey, I think we might have an opportunity here to garner this spend and this pricing and it's different than yours, are you okay with the notion that we would carve this out?" And they were like, "It's fine with us. We want to help you make the best decision. If this is going to help the district, we're okay with it." That's and frankly, I would say to you that is not because I'm looking at this with another group who has ESI. They said if you do that we will impose a penalty. >> So >> do you I don't know you know the answer to this question. Do you have to go through revive to

102do this direct to consumer program or can't these employees through their physicians because I had heard that some >> people are getting it direct to consumer with their primary >> another type of program out there where set up a plan which is outside of the healthare program where members would go to these direct to from the manufacturer. They would pay for WGO pill 199 bucks and they would submit in to a administrator separate administrator. It's called a health reimbursement arrangement H. They would they would have to pay for it submit the receipt in and it would be determined how much the district or the company would reimburse them for that uh that receipt. It's like a flexible spending. So the short answer is yes. Like that's possible and it's certainly something that we can just

103So we're talking tomorrow with your union like hey here's an alternative. We want everyone to be aware of the escalating cost. We want everyone to be aware that there's new pricing in this direct to consumer collector for employer model that the district is trying to, you know, garner. That's one way to do it as well. I would they may sort of bristle at the notion of like, wait, I have to pay for it and get reimbursed. But certainly if they were if that was something that they agreed to, then that'd be another way to do it. I just think people are going to have a problem with the fact that they're going to have to rely on some guy from Texas who they don't know telling them whether they could take a medicine or not

104that their doctor from 40 years have been telling them to take that's I'm just saying that that's what I think the push back >> that comment >> that's why like why can't we educate the doctors or like show them a way to do But this other avenue if there's a direct to consumer path why can't like somebody's primary that's in this area >> the direct to consumer pathway though would be the member like I'm okay I'm I'm prescribed the med if I'm getting it directly from the manufacturer I have to pay for that >> if I'm the member on your plan I'm like right >> I paid before >> right >> currently I just go into the pharmacy I sw I give them my card >> but they don't have to get a new doctor

105but they have to come out of pocket and then get reimbured for it, right? They're interfacing with the manufacturer. Then they're walking into the pharmacy, retail pharmacy and I'm paying a $15 co under the model of direct to I'm interfacing directly with the manufacturer. Hey, I'm getting it and I'm paying the direct to consumer pricing. So, let's just say it's 3.95 or 199 or whatever it is. I have to pay that. And then I'm gonna say wait before I was paying 15. Now I'm paying 199 and where do I go for my who's hey Abington who's paying me the money? >> So how the the potential cost savings though like we have you said there's 40 or 50 people doing this right >> 45 users >> times 1,200 or whatever the you said it's a,000

106or 1,200 per injection >> your anticipated annual >> a month. I mean, I'm talking >> 650,000, right? >> Just on this >> 650,000. And then if you did the direct, it could go from 650 down to >> like that's what this right reprice analysis is. Say here's what actually happened from January 1 through March 10th. Your cost was 95,000. Your net cost, that's what it was to you. >> And under the revive model, which is utilizing that direct to pricing, it's $39,000, >> right? So massive, right? So like figuring out that administr that's just an administrative hassle to put on people, right? We could hire somebody to do that, right? And like I'm not saying that that's even, you know, possible, but like there's got to be an administrative way to like if if it's

107just administrative, it's literally just like they can go to their doctor and there's a direct to consumer path and somebody just has to like do the administration of okay, you you pay it out of pocket and then you get reimbursed. I mean, we're we're the doing the reimbursing, right? Because we're covering it. >> So I don't disagree. I think this discussion I think part of why this was so robust just on this is because the juice I think is worth the squeeze. It's such a big number right and now we're we've brought one model forward to you to say here's one way think we can do it. The other model that you certainly mentioned Rod like the concept is an H health reimbursement arrangement right where the member is doing the work but then getting

108reimbured by the district. In essence, the district is still saying what what changed. I'm I'm giving you're still getting that and you're paying your applicable cost share, but there's two ways that done. >> And so I think our conversation tomorrow is we were making you aware of the notion that this cost is escalating. We think there may be a better way to do it that can help save the district money. And then you as well in the long term, >> here's two avenues to do it. What do you think? and I'm interested to see what they're going to say. >> Yeah. And >> in my message, like I and I'm gonna reiterate it um like many organiz this path is untenable. Ultimately, yes, the the union has to they would need to to agree to

109do this. We can't continue to do this and we'll we'll have to make some cuts because this isn't the only program that you know we're trying to um >> What a broken system. >> Yeah, >> what a broken system. I just can't believe it's $1,200 to go through all the rigamroll to get the drug that you can get for $400. There's $800 of cost here a month, >> right? That and you know I was at a meeting last week in Harrisburg and pharmacist was talking there's legislation now through Trump administration about international drug pricing bringing that >> into the United States all these companies Eli Liy all of them but it's only on selected drugs that they have agreed to reduce the cost on but what they're not telling you is these these manu manufacturers,

110they're going to reduce the cost to comply with the law on these selected drugs, but all these other drugs that they're going to bump up so that they can make their spread. >> Yep. >> Terrible. >> We wouldn't be doing our job if we didn't bring this to your attention, say, "Hey, there's something that we think may be able to >> control." >> So, do you I'm looking at the the retail versus the mail order numbers. Um, and it's only for the first three months, I guess, January through end of March. Is there a lot of savings by going mail order? >> There's definitely some. So, you're at I think it was, was it 81%. >> Yeah. So, what like our mail order numbers versus retail? It seems like it's upside down. There's not a

111lot of mail order claims being processed, but there's 10 times more going through retail for things like just generics. >> Even you said specialty, the specialty is actually more is going through retail. >> I agree. And uh this is a another conversation that we have to have at at some time. Uh, I mean this is recorded so someone may listen to it but I don't mind because I'm I'm not I'm very transparent on this is um I look at process and I look at outcome right don't diminish the integrity of the plan here's the outcome I believe that but if we can find a way to get to the same outcome but in a more cost-effective way but you have to a different process well then you should do the different process and that's where

112I'd take a look at say mail We can save money if everybody mails in. And at some point, we have to have that conversation to say, "Look, we we need to do this." Um, I know I understand you've been using the same pharmacy, but we can get you to the same exact drug or therapy and we can and we can save money. And that's what I meant by that like hyper vigilance and trying like the process changes, but the outcome doesn't. >> It's not necessarily the a different pharmacy. I mean, just do mail order for >> No, it comes from CVS. >> Well, it doesn't necessarily have comes >> It could come Well, you're I think what you're talking about is like 90day supply at retail, >> whatever. I mean, it it looks like it

113should be the other way around. >> The I mean, the current formulary tier setup is set up in a way where, for example, a formulary brand name drug is $15 at a retail 30-day supply. It's 30 at for a 90-day supply. So the member has an incentive to save one co-pay by doing that. It's in place today. I think what we'll need to examine over the next several months as the plan continues on is are there metrics that we can you know tease out like are there wins that we can get by in increasing those numbers? >> Like for example thyroid if you if you get thyroid medication you get it through mail order. You don't you don't get it through retail. >> I I think what you're maybe describing is like then you're changing

114a making edit to the plan where you're maybe mandating mail order. >> That would be just so we're aware like uh you know how the plan was being administered to ESI through ASI. We had to mirror exactly how it would be administered through Save RX. I think when you mention something like that like mandatory mail that would be a change to the plan. I think your plan holders could say, "Whoa, whoa, we didn't agree to that." >> Could you make that decision? Of course you could. You're the plan holder. >> Yeah. >> But I mean, it something like a generic mail order, it's actually way easier because you're not going anywhere. >> Some folks would argue some people want to go. >> I mean, even with controlled substances, you can get through the mail order.

115>> They want to go to the pharmacy. They want to shopping, they don't want to get it in >> and that's fine. >> Yeah. >> I think what we could do, Phil, is um >> because every company does this, >> work with the PBM to >> identify what would be projected cost savings if this population moved to mandatory or if we did mandator what would happen and present those numbers to you and then I think it would be again a discussion of is the juice worth the squeeze? Can we make this edit? Can we make this edit? Of course you can. You're the plan holder. you could do this. >> Yeah. >> And would it be what would we get by doing that? If they come back and say, "Well, if you did this, it

116would be >> $50,000." Of course, I'm just making up a number arbitrarily. Is that worth it? Could you know, is that worth it? >> But I mean, if it didn't work, companies wouldn't do it. So you you have it's cheaper for the the person, it's cheaper for the the you know the the person managing the plan and it's more efficient and it's easier like the what you said is it's an administrative nightmare. Here the administration is way less especially for generics and you know maintenance drugs and things like that. Um but specialty too I I mean that's >> point noted for sure. >> So that's one thing. Then the other thing about if this works. >> So are people required to have their BMI measured and their A1C? >> I'm not exactly sure the specific

117>> and that you know blood pressure and cholesterol. >> We'll get those answers. >> I can get back to you >> because how would you you know if it works? I think that's a big question. >> So, in just the last thing because I know you said you guys are going to look at it, but today if it happened today, what if the the uh uh what's the name? Revive doctor said no and your primary care said yes, how would you get the drug? >> I don't know. and and so we've asked them that's a takeaway for them to come back to us because we're anticipating >> so it hasn't happened yet. We haven't they haven't given us a response yet on that question that we posed to them because I was anticipating a situation

118where we have our dialogue tomorrow and I feel like that's a question that will come which is wait a minute you know when we made the transition from one PBM to another you essentially the dialogue that we had was any disruption or any difference we would grandfather the existing user we would not change something for the existing user and so it's in a similar vein I we asked that question because I anticipate it. Someone saying, "Hey, there's 45 of us right now taking this medication. If we agree to allow this new program to be implemented, how can we be assured that at least the 45 of us are not going to be disrupted today?" And uh I don't know the answer to that question. >> Well, it must happen. I mean, how often does the

119formulary change? >> Every six months. >> Yeah. And they have no choice. >> It's true. >> So, what happens today? >> Yeah. >> What happens then? The the PBM change makes a change. >> Yeah. You don't fix the number. >> Yeah. >> Right. It's possible with the plan that we're on now, if it's changing for it, >> change every six months, right? >> It was happening before and >> Right. Because it's not a guarantee. They're not getting this for life. >> N >> I think that's going to be an important point to make because I foresee going to be some push back with because it's just an extra step. I mean, Emily said like it's more of a comprehensive plan and I feel like, you know, we're always saying like excellence is a standard, right?

120Like I feel like if they're offering all these other options and safeguards to make sure that they're losing weight safely and offering all the other things that are research based like the mindfulness, exercise, all the things that help you live a healthy balanced lifestyle with the, you know, medication. Um, I mean, I think it's feels like a better method, but there's also going to be some work involved and I think it's going to be gonna be a tough sale. I'll be honest, but I'm hopeful. Something has to change because like we can't sustain this. We can't >> Yeah. I mean, >> so we appreciate this and long dialogue tonight. Thank you. >> Um if anybody should have any questions, please know they can reach out to us at any time and we're grateful to work

121with you guys and keeping up with you very soon. >> I feel like I can apply for an insurance job. So I will add that this meeting has severely damaged my >> my average like meeting length in replacing Mr. >> We will be using we'll be using mode if we use the mode you're still winning. >> All right I'll go on to the next agenda item. >> Mr. All right. I'd ask that the board consider a motion to approve the personnel report as follows. >> So punchy. >> So move. >> Second. >> On the question. >> Roll call. >> Mr. Abdala? >> Yes. >> Mr. Azar? >> Yes. >> Mrs. Henderson? >> Yes. >> Mrs. Car? >> Yes. >> Mrs. Kho? >> Yes. >> Mr. Moran? >> Yes. >> Mr. Robson? >> Yes. >> 70.

122>> Mr. Azar. Ask the board entertain a motion to approve the request to establish a student activity account. Uh the clerk summit goes pink. >> So moved. >> Second. >> On the motion. >> Roll call. >> Mr. Abdalo. >> Yes. >> Mr. Azar. >> Yes. >> Mrs. Henderson. >> Yes. >> Mrs. Kum. >> Yes. >> Mrs. Kho. >> Yes. >> Mr. Moran. >> Yes. >> Mr. Robson? >> Yes. >> 70. >> Mr. As the board consider a motion to approve the renewal contract for the food services management company for the 2627 fiscal year. >> So moved second >> on the motion. >> How how is it how is it going? The food service >> it's going well. I mean we're we we we have a surplus in our account that we we can't use for

123healthcare. >> It's just already asked that question. Uh so she's pretty ironic. >> Yeah. Yeah. Yeah. Right. So they are they they're self-sustaining so they're doing well. >> Yeah. >> Great. Anybody else? >> Roll call. >> Mr. Abdala. >> Abstain. >> Mr. Azar. >> Yes. >> Mrs. Henderson. >> Yes. >> Mrs. Carum. >> Yes. >> Mrs. Khill. >> Yes. >> Mr. Moran. >> Yes. >> Mr. Robson. >> Yes. >> Six. With one abstension. S ask the board consider a motion to approve the clinical affiliation agreement with Marywood University. >> So moved. Second >> on the motion. >> Roll call. >> Mr. Abdala? >> Yes. >> Mr. Azar. >> Yes. >> Mrs. Henderson. >> Yes. >> Mrs. Kum. >> Yes. >> Mrs. Kho. >> Yes. >> Mr. Moran. >> Yes. >> Mr. Robson. >> Yes. >>

124Seven nothing. >> Mr. asked if we consider a motion to approve the affiliation agreement for school-based internship education experience for students at Marwood School Psychology Program. >> So moved. >> Second >> on the motion. >> Roll call. >> Mr. Abdala. >> Yes. >> Mr. Azar. >> Yes. >> Mrs. Henderson. >> Yes. >> Mrs. Karum. >> Yes. >> Mrs. Kho. >> Yes. >> Mr. Moran. >> Yes. >> Mr. Robson. >> Yes. >> 70. >> Mr. Azar. ask the board consider a motion to approve the NEIU intergovernmental agreement along with board resolution for special education service. >> So moved. >> Second >> on the motion. >> Roll call. >> Sorry. Mr. Abdullah. >> Yes. >> Mr. Aar. >> Yes. >> Mrs. Henderson. >> Yes. >> Mrs. Kum. Yes. >> Mrs. Kho. >> Yes. >> Mr. Moran. >>

125Yes. >> Mr. Robson. >> Yes. 70. >> Great. Thank you, Dr. Schaefer. Next item on the agenda is justformational. The use of facilities updated for April. And then the next two items, does anybody have any unfinished business or new business to discuss? >> Mr. Abdala, >> real quick. So going back to Clark Summit goes pink. Gretchen and I were at the uh inauguration of it. So they just wanted me to um highlight it. It says Clark Summit Goes Pink is a newly formed nonprofit. goals to raise awareness and money for breast cancer. Fund raises will be spent on those in need in our local community nea. Abington Heights High School has a Clark Summit goes pink club that we just approved to help support our events. Debbie Musgrave is the faculty adviser. Kids are helping

126coordinate volunteers and support fundraising, solicit donations of baskets for the basket raffle fundraiser are for our main the main events are. So, the kids are going to run the Clark Summit Goes Pink Carnival at the Hillside Community Center on July 10th. Then there's the 5K1M funwalk, followed by community block party on August 15th. The Wright Center is a presenting sponsor. Entertainment at the block party is by Kristen and the noise. The PA, this is a big deal from what I understand. The PA breast cancer coalition only does this a couple times a year. They're bringing their travel photo exhibit display to the Waverly Community House leading up to the event from August 6th to 14th. There will be opening reception to kick off the exhibit on August 6th. Anyone looking to get involved can contact

127myself or Debbie Musgrave. >> Great. Awesome. Thank you very much. >> Thank you. >> Anybody else? Any new business? >> Just uh one other thing, you know, I haven't given an IT report lately. We did get on the agenda for May 20th. Great. We're going to limit it to six minutes, but it'll be more >> it'll be across the year. >> Okay. >> Of what we're what we've done, what we're going to do. >> That's great. Excellent. Anyone else? >> All right. Seeing nothing further, I have a motion to adjurnn. So move. >> So move. >> Thank you.